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This summer, town hall meetings to discuss health care reform have turned into battlegrounds—with fist fights, belligerent protestors, and at least one lawmaker reporting a death threat. Some Democrats have blamed the chaos on astroturf operations: fake grassroots groups funded by special interests. But are the forces whipping up the anti-health care frenzy really astroturf—or a new form of corporate-funded campaigning?

Most astroturf operations are semi-covert activities, precisely targeted at vulnerable or undecided lawmakers. Tried-and-true practices include phone banks in which paid callers posing as concerned voters read from prepared scripts, or phony citizens groups with few members, if any, but plenty of industry money to bankroll television ads and mailers. Particularly unscrupulous operators might mobilize a narrow constituency—like conservative Christians—on behalf of their corporate clients. The idea is to create the impression of grassroots activism, but rarely to seriously attempt to influence broader public opinion. Michael Scanlon, a colleague of disgraced uberlobbyist Jack Abramoff, once captured the logic succinctly: “Simply put we want to bring out the wackos to vote against something and make sure the rest of the public lets the whole thing slip past them.”

By that standard, some of the groups orchestrating town hall protests against Obama’s health care reform have adopted a new, hybrid model—one that blurs the lines between astroturf and grassroots activism. As far as it’s possible to tell, their financial base remains heavily dependent on corporate interests, and some of their tactics are familiar, too. But instead of furtively targeting selected lawmakers, they’re also mounting highly visible outreach efforts via public forums and Facebook, Twitter, and other social networking tools. In the process, they’re picking up at least some genuine support. It remains to be seen whether they can attract large numbers to their cause, but already they’ve helped to hijack the health care debate at a critical juncture. Here’s MoJo‘s guide to the major groups and their backers.

Americans for Prosperity

Americans for Prosperity is one of the most prominent groups opposing the Obama administration’s two key domestic policy goals: health care reform and cap and trade. The organization presents itself as a grassroots movement that espouses limited government. But a large portion of its money comes via staunch free-market conservative David Koch, part owner of Koch Industries, an oil and gas conglomerate that is perhaps the largest privately owned company in the US, with holdings in medical device and pharmaceutical companies.

Koch helped found AFP in 2003 and serves as chairman of its affiliated foundation. Its president is Tim Phillips, a master of the art of astroturf. Along with Ralph Reed, he cofounded Century Strategies, a PR and consulting firm known for effectively renting out Reed’s evangelical Christian allies to its clients—not to mention clients of Jack Abramoff. In 1999 and 2000, Century mobilized anti-gambling evangelicals to protest proposed casinos—but didn’t know Century was working for an Abramoff client, a casino-owning Indian tribe hoping to vanquish its competition. In a memo, an Abramoff colleague noted that Century’s Christian connections would ensure a “political effort that truly resembles a people’s movement” without the signs of a “paid political operation.”

This year, AFP is devoting its deep resources and strategic prowess to organize protests at Democratic health care town hall meetings, where activists hold signs like “Sorry Grandma, No Health Care for You.” But unlike most typical astroturf operations, AFP’s efforts seem intended to gather a broader base of supporters. To that end, the group makes use of social networking sites to reach out to potential followers. It posts information about local events and organizing strategies for its nearly 4,500 fans on Facebook, who share YouTube videos of protests. More than 1,000 people rallied at an August event in Scottsdale, Arizona, organized by AFP; the local fire department was called to handle overflow.

AFP sponsors two other groups advocating against the Obama administration’s proposed reforms, innocuously titled Patients United Now and Patients First. Both fund ads that make misleading claims. One Patients United Now television ad wrongly asserts that “Washington wants to bring Canadian-style health care to the US.” Patients First also launched a 13-state bus tour that wraps up at the end of August. At one stop a speaker compared proposed reforms to the Stalin and Hitler regimes because they would lead to “physician-assisted suicide”—a blatantly false claim. But these outlandish accusations have proved convincing to some: More than 206,000 people have signed Patients First’s petition opposing current health care reform proposals.

FreedomWorks

FreedomWorks is headed by former GOP House majority leader Dick Armey, who left government in 2003 and became a heavy-hitting lobbyist for DLA Piper, whose numerous corporate clients include pharmaceutical firms.

FreedomWorks grew from a group called Citizens for a Sound Economy, which was founded in 1984 and whose resume includes orchestrating “grassroots” opposition to cigarette taxes on behalf of Philip Morris. In 2006, the Washington Postreported that the group had once duped nearly 16,000 people into swelling its membership rolls: Brokers for a company called Medical Savings Insurance Co. pitched patients on discounted insurance, and those who signed up automatically became members of Citizens for a Sound Economy. (A small part of their monthly bill also went to the group, eventually netting it more than $600,000.) In 2003, a spokesman acknowledged that two-thirds of the organization’s money came from corporations, as well as corporate-funded conservative foundations. The next year, CSE morphed into FreedomWorks. Last year, the organization was identified as the creator of AngryRenter.com, an amateur-looking website presented as a spontaneous effort from ordinary Americans opposing government mortgage relief for homeowners.

The arrival of the Obama administration has ushered in a busy year for FreedomWorks, which played a pivotal role in engineering “tea party” protests against government spending. The group distributed organizational tips and talking points and helped to coordinate gatherings around the country that garnered breathless media coverage. FreedomWorks operatives have urged followers to mimic the tactics of the grandfather of community organizing—and inspiration to Barack Obama—Saul Alinsky.

This summer, FreedomWorks is using those tactics to defeat health care reform. It claims a membership of more than 770,000 people and an email list of 400,000 readers. Its website provides numerous resources, including an “August Recess Action Kit” to aid supporters in exposing “the real intentions and the economic ramifications of the Cap and Tax and health care reform legislation on the table.” FreedomWorks has plotted locations of town halls on Google Maps; one memo encouraged supporters to “rattle” lawmakers at these forums. FreedomWorks is also sponsoring a march on Washington on September 12.

In mid-August, Armey abruptly announced that he was leaving DLA Piper after a flurry of media reports raised questions about whether FreedomWorks activities were related to the goals of the firm’s big pharma clients.

Coalition to Protect Patients’ Rights

The Coalition to Protect Patients’ Rights describes itself as a “nonpartisan, grassroots coalition of patients, healthcare professionals, advocacy groups, and engaged citizens.” Its source of funding is unknown. However, according to Think Progress, PR for the organization is managed by the DCI Group, a political consulting firm with a long history of rustling up phony advocacy groups to serve the interests of its corporate clients.

DCI’s managing partners have deep experience in the political dark arts. Tom Synhorst, for instance, is a former associate of Ralph Reed (as well as a former aide to GOP Sen. Chuck Grassley of Iowa). Synhorst and fellow founding partners Doug Goodyear and Tim Hyde spent years working for or with the tobacco conglomerate RJR Nabisco, where they supported “smokers’ rights” groups.

In the 1990s, DCI generated fake “citizen” letters opposing the breakup of Microsoft, then under investigation for antitrust violations. At least two of the letters were from dead people. During the Bush years, DCI created fake “grassroots” groups to champion one of the administration’s pet causes, privatizing Social Security. And in 2005, Freddie Mac paid DCI $2 million to drum up opposition to a bill that would have reined in the mortgage giant and its sister, Fannie Mae—three years before they nearly collapsed under the weight of their subprime loans.

Its resume also includes several health care campaigns: In 2002, DCI was hired by the Health Benefits Coalition—an HMO trade association—to defeat a proposed “patients’ bill of rights” in Congress. In 2003 and 2004, DCI worked with Pharmaceutical Research and Manufacturers of America (PhRMA) to pass the GOP’s Medicare prescription drug bill, going so far as to pay health care consultants to find elderly people to speak positively about the proposal.

The face of the Coalition to Protect Patients Rights (CPPR) is Dr. Donald J. Palmisano, a former American Medical Association president whose idea of protecting patients’ rights consists of trying to limit their ability to sue doctors for malpractice. A longtime shill for the tort-reform movement, Palmisano sits on the board of the Doctors Company, a medical liability insurance company, and founded a claims review company that serves physicians and hospitals.

This year, CPPR’s efforts to kill health care reform are more visible and more ambitious than many previous initiatives linked with DCI. It is aggressively seeking supporters for the anti-reform cause via press events, op-eds, a Facebook page, and its Twitter feed, which so far has a modest 1,485 followers. (Sample tweet: “POTUS says you will be able to keep your insurance…but will your insurance survive competition with a public option?”) CPPR has also organized a group of doctors to tour the country warning of the perils of single-payer care. At one recent press conference that it sponsored, a physician said that in countries with government-run health care, the “sickest patients” are denied treatment.

60 Plus

60 Plus presents itself as a “grassroots senior citizen organization.” Although it claims to be nonpartisan, it was formed with help from stalwart conservative direct-mail king Richard Viguerie and refers to its honorary chairman Roger Zion as “one of Washington’s leading spokesmen for the conservative cause.” This year, it’s run a more traditional astroturf operation opposing the administration’s health care proposals.

During the Bush administration, 60 Plus was linked to several dubious political campaigns, and had ties to Jack Abramoff. The investigation of the lobbyist revealed that in 2001, Abramoff told one of his clients, the Coushatta Tribe of Louisiana to give $25,000 intended for Tom DeLay’s political action committee to 60 Plus, although the tribe’s primary interest was in gambling legislation. (A lawyer for the tribe said that Abramoff advised them that the donation would help the tribe win clout with the Republican leadership in Congress.)

But for several years Big Pharma was 60 Plus’ major benefactor. According to a 2006 investigation by the AARP Bulletin, the pharmaceutical industry accounted for “virtually all of [60 Plus’] largest contributions” in the early years of this decade. In return, the group lobbied hard against state laws that would have reduced prescription-drug prices. On one occasion, the industry hired Bonner & Associates (a Washington strategic operation currently being investigated by Congress for forging letters opposing cap and trade and sending them to lawmakers). Bonner paid callers to read from scripts that identified them as members of 60 Plus and urged citizens to tell their governor to veto the legislation. Pfizer later admitted to funding the calls. Ken Johnson Sr., a vice president of PhRMA, told Mother Jones that the organization has not given 60 Plus any money since 2004.

This year, 60 Plus has been tirelessly working to torpedo Obama’s health care reform with a series of misleading and alarmist ads. On August 10, 60 Plus released a television ad warning that “The government—not doctors—will decide if older patients are worth the cost.” A recent mailing from 60 Plus told recipients that proposed changes to Medicare would mean “longer wait times at hospitals and doctors’ offices, less money for new treatments, restrictions on care, prescriptions and what’s best for you—the patient!” And a flyer distributed in Nebraska by 60 Plus features a picture of ailing elderly people and quotes Obama out of context saying, “Maybe you’re better off not having the surgery, but taking the painkiller.”

Conservatives for Patients Rights

CPR was founded by discredited hospital executive Rick Scott, who has emerged as perhaps the most dogged opponent of a Medicare-style public option that would cover uninsured Americans. To sell its message, CPR has enlisted the services of the same PR firm that brought you the Swiftboating of John Kerry: CRC Public Relations. So it should come as no surprise that its million-dollar ads on television and talk radio feature highly questionable assertions to scare citizens into sticking with the status quo. In one ad, an announcer ominously intoned that reform “could put a bureaucrat in charge of your medical decisions, not you.” A CPR flyer referred to the public option as “Patient Enemy #1.”

Scott claims that he will spend as much as $20 million dollars to defeat health care reform—he has already kicked in $5 million of his own funds to jump-start CPR’s media blitz. As Mother Jones has previously reported, he owns an urgent care company called Solantis. That gives him a direct incentive to block the expansion of health insurance coverage. To that end, CPR has sought to whip up frenzies at town hall forums during the August congressional recess, issuing alerts for meetings around the country and posting video footage of heated exchanges on its website. Earlier this month, White House press secretary Robert Gibbs denounced CPR for “organizing and manufacturing that anger.”

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